Hepatitis B: Ensuring early detection and effective treatment

With this year’s World Hepatitis Day 2024 theme, “It’s Time for Action”, Dr Liew Shan Fap, Consultant Physician and Gastroenterologist at Timberland Medical Hospital, Kuching, discusses the infection that affects the liver, a sickness that can potentially change a person’s life for the worse.

Taking Action for Liver Health

Hepatitis B was likened to a forest engulfed in a massive fire by Dr Liew Shan Fap, Consultant Physician and Gastroenterologist at Timberland Medical Hospital, Kuching. He explained that a high viral load of the hepatitis B virus corresponds to a higher risk of liver damage, similar to how a large fire would cause more extensive damage to a forest. Conversely, a smaller fire, representing a lower viral load, would have a lesser chance of worsening liver damage.

“If there is a big fire, the forest will burn faster. Conversely, with a small fire, the damage will be lessened. The same applies to hepatitis B. If the viral load is higher, the risk of liver damage is also higher. Therefore, treatments, preventive measures, and hepatitis B awareness are important.”

Every year on July 28, the world observes World Hepatitis Day. This year’s theme, “It’s Time for Action”, encourages increased awareness of hepatitis, a condition that causes inflammation of the liver, leading to severe liver diseases and cancer. Although there are various strains of the hepatitis virus, the focus of this article is on hepatitis B, which is the most common strain in Malaysia.

According to the World Health Organization (WHO), 304 million people were living with chronic hepatitis B and C in 2022. While 45 per cent of babies received the hepatitis B vaccine within 24 hours of birth in 2022, 1.3 million people died from chronic hepatitis B and C in the same year.

In Malaysia, the Ministry of Health reported in 2022 that 16.02 per 100,000 people were diagnosed with hepatitis B, while 0.33 per 100,000 had died from it. Given the seriousness of these figures, Dr Liew emphasised the importance of raising awareness about the disease, promoting treatments, and practicing preventive measures.

“Many individuals do not receive treatment for various reasons. Sometimes it is due to low awareness, and sometimes it is because of the fear of social stigma. These factors contribute to delays in treatment, which can lead to complications such as cirrhosis (liver hardening) and, in some cases, liver cancer.”

Hepatitis B and its symptoms

Hepatitis B is a viral infection that affects the liver and can lead to both acute and chronic liver disease. In its early stages, hepatitis B can be asymptomatic. However, in later stages, the infection may present symptoms that lead to liver inflammation.

According to Dr Liew, the most common symptom is jaundice — a yellow discolouration of the skin and the sclera (the white part of the eyes).

“Other symptoms include fatigue, dark-coloured urine, nausea and vomiting, abdominal pain, and loss of appetite. Occasionally, joint pain may also occur.”

In the advanced stages of hepatitis B, the liver may progress to cirrhosis (hardening) or liver cancer. Severe symptoms can also include fluid retention, gastrointestinal bleeding, “and when the liver can no longer produce albumin, patients may develop oedema — swelling of the limbs and even the entire body,” the gastroenterologist specialist added.

As the condition reaches its most advanced stage, liver function deteriorates (decompensation), leading to further hardening and ultimately liver failure. Dr Liew explained that at this stage, patients may go into a coma or pass away.

In explaining the symptoms, Dr Liew emphasised the importance of regular blood screening for the early diagnosis and treatment of hepatitis B.

Treatment, preventive and care

When diagnosed, treatment options include oral medications. Dr Liew mentioned that the chances of curing the disease with these drugs are high. Another option is a liver transplant; however, this method carries risks and complications, making it not always viable. Additionally, the limited availability of donor livers further exacerbates these limitations.

With that said, the doctor emphasises the importance of prevention and care measures for managing the illness.

“It is important to undergo regular screenings during medical check-ups to detect hepatitis B. For people with hepatitis B infection, it is recommended to have regular blood tests and liver ultrasounds every six months to screen for early liver cancer. Patients with hepatitis B should also monitor their viral loads with their doctors.

“Treating patients with antiviral medications can potentially prevent liver hardening, reduce the risk of liver cancer, and decrease the likelihood of hepatitis B flare-ups, which can cause severe liver inflammation.”

Dr Liew explained there are four modes of transmission:

• Perinatal Transmission: From mother to child at birth.
• Horizontal Transmission: Early childhood infections through close interpersonal contact.
• Parenteral Transmission: Exposure to infected blood through shared needles (intravenous drug use); unsterilised medical equipment; and blood transfusions (rare nowadays due to screening).
• Sexual Transmission: Unprotected sex with an infected person.

Dr Liew added that since 1989, Malaysia has implemented a universal vaccination programme to offer the hepatitis B vaccine at birth. The public is also encouraged to get vaccinated when their immunity against the virus is low to prevent infection.

To reduce perinatal transmission, mothers can be treated during pregnancy to lower their hepatitis B viral load. At birth, newborns of mothers with hepatitis B infection will receive a hepatitis B immunoglobulin injection in addition to the routine hepatitis B vaccine to reduce the risk of transmission.

Meanwhile, patients diagnosed with the infection should avoid activities that may cause further liver damage.

“Regular alcohol intake can exacerbate liver damage. Therefore, those with hepatitis B are advised to lead a healthy lifestyle, which includes eating a balanced diet, avoiding alcohol, and not consuming unnecessary medications like painkillers, steroids, or traditional medicines that are often not properly studied — all of which can impair liver function.”